Effectiveness of the advisory display SmartPilot® view in the assessment of anesthetic depth in low risk gynecological surgery patients: a randomized controlled trial

Background: Assessment of appropriate anesthetic depth is crucial to prevent harm to patients. Unnecessary deep anesthesia can be harmful, potentially causing acute renal failure, myocardial injury, delirium, and an increased mortality rate. Conversely, too light anesthesia combined with muscle relaxants can result in intraoperative patient awareness and lead to serious psychological trauma. This trial aimed to ascertain the efectiveness of the advisory display SmartPilot View (SPV), as a supplemental measure in the assessment of anesthetic depth in low risk gynecological surgery patients. The hypothesis was that the use of the SPV would increase the precision of assessment, and result in a higher mean arterial pressure. Methods: This trial used a randomized, controlled, single-blind design with a homogeneous sample. Patients undergoing minor, low risk gynecological surgery were randomly assigned to two groups: a test group wherein current standards were supplemented with the advisory display SPV and a control group assessed using only the current standards. Female patients aged between 18 and 75 years with American Society of Anesthesiologists Physical Status Classifcation System scores of 1–3 undergoing planned general anesthesia using the total intravenous anesthetic method, combining propofol and remifentanil, were included. The exclusion criteria included a body mass index≥35 kg/m2 , a history of alcoholism, drug intake afecting propofol and remifentanil dynamics, and inability to consent. The independent sample t-test and chi-square test or Fisher’s exact test were used to assess the statistical signifcance of diferences between the two groups. Results: A total of 114 patients were included in the analysis (test group n=58, control group n=56). No signifcant diferences in the mean arterial pressure, heart rate, bispectral index, extubation delay, or post-anesthesia care unit stay were found between groups. Conclusions: The addition of the advisory display SmartPilot® View to current standards in the evaluation of anesthetic depth had no signifcant efect on the outcome. Trial registration: The trial was registered on January 16th 2019 with ClinicalTrials.gov (ref: NCT03807271).The trial was funded by Innlandet Hospital Trust and the Norwegian University for Science and Technology (NTNU). The funders had no role in the design of the study, data collection, analysis, interpretation of the data or writing the manuscript.publishedVersio

The Swedish version of the TeamSTEPPS® teamwork attitudes questionnaire (T-TAQ): A validation study

Background Effective teamwork is essential for delivering safe health care. It is important to increase patient safety in healthcare by conducting interprofessional team training with both healthcare professionals and undergraduate students. Validated questionnaires that evaluate team training activities contribute to valuable knowledge regarding changes in attitudes toward teamwork. The aim of the study was to test the reliability and structural validity of the Swedish version of the TeamSTEPPS® Teamwork Attitudes Questionnaire (T-TAQ). Methods The study had a cross-sectional design. Four hospitals in three health care regions in Sweden participated in the study. In total, 458 healthcare professionals, response rate 39.4%, completed the questionnaire. The T-TAQ, which consists of 30 items and covers five dimensions (Team Structure, Leadership, Situation Monitoring, Mutual Support and Communication), was translated to Swedish. A paper version of the T-TAQ was distributed to healthcare professionals (physicians, registered nurses, midwives, nursing assistants and allied health professionals) from the hospitals. Reliability and validity were tested using Cronbach’s alpha and confirmatory factor analysis. Results Cronbach’s alpha was 0.70 for the total T-TAQ and ranged from 0.41 to 0.87 for the individual dimensions. The goodness-of-fit indexes in the confirmatory factor analysis (Model 2) revealed a normed chi-square of 2.96, a root mean square error of approximation of 0.068, a Tucker-Lewis index of 0.785 and a comparative fit index of 0.808. Conclusions The Swedish version of the T-TAQ has some potential to measure healthcare professionals’ general attitudes toward the core components of teamwork in hospital settings. Further validation studies of the Swedish version of the T-TAQ are required, with samples representing both healthcare professionals and students from various healthcare disciplines and educational levels.publishedVersio

Translation and psychometric testing of the Norwegian version of the “Patients’ Perspectives of Surgical Safety Questionnaire”

Purpose To translate the Patients’ Perspectives of Surgical Safety (PPSS) questionnaire into Norwegian and to test it for structural validity and internal consistency. Design This is a methodological study. Methods The original 20-item PPSS questionnaire was translated into Norwegian using a model of translation-back translation. We assessed content validity via a pretest with 20 surgical patients. A sample of 218 surgical patients in a university hospital in Norway completed the PPSS questionnaire. Psychometric analysis included item characteristics, and structural validity was evaluated by an exploratory factor analysis. Internal consistency was calculated using Cronbach's alpha. Findings We successfully translated and adapted the Norwegian PPSS questionnaire. Completion rate was 74%. Missing values were less than 5% and all 20 items had a high skewness (≥15 %) ranging from 52.8% to 95.9%. The exploratory factor analysis yielded two significant factors that explained 45.15% of variance. The Cronbach's alpha for Factor 1 “Team interaction safety” was 0.88 and for Factor 2 “Patient's ID safety”, 0.82. Overall, most patients reported a high sense of surgical safety. Conclusions The first Norwegian version of the PPSS measuring surgical patients’ perception shows promising psychometric properties regarding structural validity and internal consistency. However, future research on PPSS should provide an examination of construct validity, validation and testing in other populations of surgical patients. To improve safety of the surgical trajectory, it is necessary to pay more attention to patients’ perceptions of surgical safety.publishedVersio

Building patient safety in intensive care nursing : Patient safety culture, team performance and simulation-based training

Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven ICUs and ten RNs from a post-graduate programme (II). The data were collected with questionnaires (II) and measurement scales (III), and analysed with statistics. In Study IV, 18 RNs were interviewed and the data were analysed with a qualitative content analysis. Main findings: The RNs had positive perceptions of the overall patient safety culture in the ICUs. Hence, a potential for improvements was identified at both the unit and hospital level. Differences between types of ICUs and between hospitals were found. The dimensions at the unit level were predictors for the outcome dimensions (I). The RNs evaluated the simulation-based team training programme in a positive way. Differences with regard to scenario roles, prior simulation experience and area of intensive care practice were found (II). The expert raters assessed the teams’ performance as advanced novice or competent. There were differences between the expert raters’ assessments and the RNs’ self-assessments (III). One main category emerged to illuminate the RNs’ perceptions of simulation-based team training for building patient safety: Regular training increases the awareness of clinical practice and acknowledges the importance of structured work in teams (IV). Conclusions: Patient safety culture measurements have the potential to identify areas in need of improvement, and simulation-based team training is appropriate to create a common understanding of structured work in teams with regard to patient safety.Baksidestext Intensive care represents potential patient safety challenges for critically ill patients. Human errors are the most common cause of incidents, and failures in team performance are identified as contributory factors. The measurements of patient safety culture and simulation-based team training are recommended initiatives to improve patient safety. The aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. The nurses had a positive perception of the overall patient safety culture. A potential for improvements were found in incident reporting, feedback and communication about errors and organizational learning. The RNs evaluated the simulation-based team training programme in a positive way. The assessments of nurses’ team performance with respect to communication, leadership and decision-making in a simulation-based emergency situation showed a variation in competencies from advanced novice to competent. There were differences between expert raters’ assessments and nurses’ self-assessments. The nurses perceived that simulation-based team training on a regular basis increases the awareness of clinical practice and acknowledges the importance of structured teamwork

Longitudinal team training programme in a Norwegiab surgical ward: a qualitative study of nurses' and physicians' experiences with teamwork skills

Objectives Teamwork and interprofessional team training are fundamental to ensuring the continuity of care and high-quality outcomes for patients in a complex clinical environment. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based team training programme intended to facilitate healthcare professionals’ teamwork skills. The aim of this study is to describe healthcare professionals’ experiences with teamwork in a surgical ward before and during the implementation of a longitudinal interprofessional team training programme. Design A qualitative descriptive study based on follow-up focus group interviews. Setting A combined gastrointestinal surgery and urology ward at a hospital division in a Norwegian hospital trust. Participants A convenience sample of 11 healthcare professionals divided into three professionally based focus groups comprising physicians (n=4), registered nurses (n=4) and certified nursing assistants (n=3). Interventions The TeamSTEPPS programme was implemented in the surgical ward from May 2016 to June 2017. The team training programme included the three phases: (1) assessment and planning, (2) training and implementation and (3) sustainment. Results Before implementing the team training programme, healthcare professionals were essentially satisfied with the teamwork skills within the ward. During the implementation of the programme, they experienced that team training led to greater awareness and knowledge of their common teamwork skills. Improved teamwork skills were described in relation to a more systematic interprofessional information exchange, consciousness of leadership-balancing activities and resources, the use of situational monitoring tools and a shared understanding of accountability and transparency. Conclusions This study suggests that the team training programme provides healthcare professionals with a set of tools and terminology that promotes a common understanding of teamwork, hence affecting behaviour and communication in their daily clinical practice at the surgical ward.publishedVersio

Longitudinal team training program in a Norwegian surgical ward: a qualitative study of nurses’ and physicians’ experiences with implementation

Background Team training interventions to improve team effectiveness within healthcare are widely used. However, in-depth knowledge of how healthcare professionals experience such team training curricula and their implementation processes, as well as how contextual factors impact implementation, is currently missing. The aim of this study is therefore to describe healthcare professionals’ experiences with the implementation of a longitudinal interprofessional team training program in a surgical ward. Methods A descriptive design was applied based on qualitative semi-structured focus group interviews with 11 healthcare professionals. A convenience sample of physicians (n = 4), registered nurses (n = 4), and certified nursing assistants (n = 3) was divided into three professionally based focus groups, which were interviewed at three time intervals over a period of 1 year. Intervention The validated and evidence-based team training program Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was implemented in a surgical ward at a hospital between January 2016 and June 2017. The team training program included three phases: 1) assessment and planning, 2) training and implementation, and 3) sustainment. Results Healthcare professionals’ experiences with the content of the team training program varied from valuing the different elements of it to seeing the challenges in implementing the elements in clinical practice. A one-day training course was found to be especially beneficial for interprofessional collaboration at the ward. Over time, the nursing staff seemed to maintain their motivation for the implementation of the tools and strategies, while the physicians became less actively involved. Contextual ward factors influenced the adoption and utilization of the tools and strategies of the program both positively and negatively. The healthcare professionals’ experienced the implementation of the team training program as positive for the patient safety culture at the ward in the forms of increased awareness of teamwork and open communication. Conclusions The study suggests that the implementation of a team training program in a surgical ward is dependent on a set of factors related to content, process, context, and impact. Knowledge on how and why a team training program work supports the transferability to clinical practice in further planning of team training measures.publishedVersio

A Complex Teamwork Intervention in a Surgical Ward in Norway

Objectives Interprofessional team training has a positive impact on team behavior and patient safety culture. The overall objective of the study was to explore the impact of an interprofessional teamwork intervention in a surgical ward on structure, process and outcome. In this paper, the implementation of the teamwork intervention is reported to expand the understanding of the future evaluation results of this study. Results The evidence-based Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program was implemented in three phases according to the program’s implementation plan, which are built on Kotter’s organizational change model. In the first phase, a project group with the leaders and researchers was established and information about the project was given to all health care personnel in the ward. The second phase comprised 6 h interprofessional team training for all frontline health care personnel followed by 12 months implementation of TeamSTEPPS tools and strategies. In the third phase, the implementation of the tools and strategies continued, and refresher training was conducted. Trial registration Trial registration number (TRN) is ISRCTN13997367. The study was registered retrospectively with registration date May 30, 2017publishedVersio

Longitudinal team training programme in a Norwegiab surgical ward: a qualitative study of nurses' and physicians' experiences with teamwork skills

Objectives Teamwork and interprofessional team training are fundamental to ensuring the continuity of care and high-quality outcomes for patients in a complex clinical environment. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based team training programme intended to facilitate healthcare professionals’ teamwork skills. The aim of this study is to describe healthcare professionals’ experiences with teamwork in a surgical ward before and during the implementation of a longitudinal interprofessional team training programme. Design A qualitative descriptive study based on follow-up focus group interviews. Setting A combined gastrointestinal surgery and urology ward at a hospital division in a Norwegian hospital trust. Participants A convenience sample of 11 healthcare professionals divided into three professionally based focus groups comprising physicians (n=4), registered nurses (n=4) and certified nursing assistants (n=3). Interventions The TeamSTEPPS programme was implemented in the surgical ward from May 2016 to June 2017. The team training programme included the three phases: (1) assessment and planning, (2) training and implementation and (3) sustainment. Results Before implementing the team training programme, healthcare professionals were essentially satisfied with the teamwork skills within the ward. During the implementation of the programme, they experienced that team training led to greater awareness and knowledge of their common teamwork skills. Improved teamwork skills were described in relation to a more systematic interprofessional information exchange, consciousness of leadership-balancing activities and resources, the use of situational monitoring tools and a shared understanding of accountability and transparency. Conclusions This study suggests that the team training programme provides healthcare professionals with a set of tools and terminology that promotes a common understanding of teamwork, hence affecting behaviour and communication in their daily clinical practice at the surgical ward

A qualitative study of how inter-professional teamwork influences perioperative nursing

Abstract Aim: To explore Norwegian operating room nurses’ perceptions of how team skills in the inter-professional operating room team influence perioperative nursing in rela-tion to patient safety. Design: A qualitative, descriptive study based on interviews. Methods: Ten operating room nurses (N = 10) employed in four Norwegian hospi-tals were interviewed individually. A qualitative inductive content analysis was con-ducted. The study was reported adhering to the Consolidated Criteria for Reporting Qualitative Research Checklist. Results: Three generic categories, containing three subcategories each, were identi-fied illuminate the operating room nurses’ perceptions. The operating room team's team skills influence on (a) the quality of perioperative nursing, about task perfor-mance, result for the patient and learning; (b) the progress of perioperative nursing, by keeping focus on the task, being prepared and task distribution and (c) the oper-ating room nurses’ work environment in the operating room, including confidence, stress and energy use and irritation or job satisfaction. KEYWORDS: operating rooms, patient safety, perioperative nursing, TeamSTEPPS®, teamwor